Amblyopia is the most common form of unilateral vision loss affecting over 10 million individuals in the US alone. It is a disease of the visual system that impacts the lives of 2-4% of the world’s population yet occurs in the absence or removal of ocular pathology. Amblyopia is a serious visual problem that has been recognized for centuries as the inability to see in one eye compared to the other, even with corrective lenses.
However , there is an overwhelming amount of research evidence that shows amblyopia impacts a person in more than visual acuity (eye sight) alone. The amblyopic individual has poor depth perception, dysfunction in micro-eye movements affecting reading fluency, visual perception and processing ability causing poor judgments, deficiencies in eye hand and general coordination leading to errors in visually directed motor behaviors.
Modern neuroscience has provided us with the complete understanding for the cause of Amblyopia too. We know that Amblyopia is a preventable developmental disorder of binocular vision. That means if there is a disruption in a child’s ability to use their two eyes either due to eye teaming failure (strabismus), unequal refractive error (anisometropia) or congenital cataracts during the sensitive developmental period of a child’s life, between age 6 weeks and 6 years, then amblyopia will occur.
But, there is something else very wrong with this picture. Why? Because, if amblyopia is such a serious disease of the visual system affecting millions of children and adults, why has it earned the distinct trademark in medicine known as “Lazy Eye”! Why would such a serious disease be associated with the pejorative, “Lazy”?
Indeed, it is the kind of question one might have expected from the great comedian George Carlin. If a child has a lazy eye, it must be because they brought it upon themselves, right? Carlin may have said, “Come on, how hard can it be to work your two eyes together. Oh, those kids with lazy eye, they simply did not try hard enough! After all, look at all the “normal” kids who can make their eyes work together, just like play! That kid who can’t do something as simple as make his own eyes play together must be really lazy!”
Take it a step further. You learn from a school eye test that your child is having trouble seeing with one eye. So, you go to the eye doctor only to learn that your child has a condition called lazy eye and then what are you told? They have a “good eye” and a “bad-lazy eye”. To take care of the problem, the “good eye” must be penalized by wearing a cover (eye patch) to force the “bad-lazy eye” to work harder. So as a good parent you go along with the treatment and place the patch on the normally seeing eye only to watch your child act out and refuse to wear the patch. Obviously, another “lazy ” behavior to avoid the work of treatment!
Well what can you do? You have a child with one eye that is a “couch potato” and they don’t want to even wear a simple eye patch to fix it. They behave like they would rather live with the problem and just be “lazy” about it!
Let’s get serious! There simply is no other disease in modern healthcare that affects one side of the body or one organ and has earned the term “lazy”. If you have a child with only partial hearing in one ear, it is not referred to as “lazy ear”. If you have a child with only one working kidney you do not refer to the other as a “lazy kidney”. So why “lazy eye” for amblyopia?
There are many plausible explanations dating back centuries in medicine. But a bigger question is why, in the year 2015 have modern methods in eye care not been able to let go of an outdated mindset of amblyopia that dates back to the 1700’s?
The modern truth is that amblyopia is a serious vision disorder that has nothing to do with a person being lazy or an eye being lazy. Amblyopia is due to a binocular vision problem that affects the entire visual brain not one eye. The common form of treatment known as occlusion therapy (patching) and/or penalization, while it has been the gold standard of care for decades, has a well documented track record of serious negative side effects and limited outcomes.
Fortunately, now there is overwhelming neuroscience that shows that there is another approach to effectively treating amblyopia. Instead of occlusion therapy that has a slow response time, is harsh on the patient and the family trying to enforce its on their child and has limited results, there is a new better way that is enjoyable to the patient, gets faster and better results and improves more than just visual acuity alone. The new emerging treatment paradigms involves binocular vision therapy woven into a computer gaming modality. When done under the supervision of the doctor and vision therapist, the patient responds faster, better and without resistance to treatment. And what’s more, research has shown, with binocular vision treatment in the form of perceptual learning, there is plasticity even in the adult brain. That’s right, with modern treatment amblyopia can even be successfully treated in adults.
However while we have a new and improved treatment for amblyopia, there still exists a bigger issue. Before we can embrace a new and advanced treatment for a serious vision disorder, there is a critically important first step that must precede it and that is the dialog. We must begin with a new conversation. This post is a call for support and recognition by all eye care professionals to dismiss the outdated, confusing and negative term “Lazy Eye”. It should be removed from our professional and public vernacular. The condition is Amblyopia. But, as long as we refer to this vision condition with a pejorative “lazy”, implying derogatory judgment, the longer it will take the doctors and the public to think if this condition as a serious visual problem that deserves a more serious approach in treatment than an eye patch, even when the research shows otherwise.
If you agree, how can you help with this effort to bring about a change in the way those with amblyopia (children and adults) are cared for by health care professionals? It begins by how we speak about amblyopia, not as “Lazy Eye” but as Amblyopia. Your help begins simply by sharing this message and allowing it to have social significance. By all means, if you have been affected by amblyopia (either as a parent of a child, or as an adult with amblyopia), your personal experience and comments are also welcomed.
Together, doctors and a concerned public, we can make a difference in the lives of those have been touched by amblyopia so that this serious vision problem no longer causes people to endure the frustration and emotional association of an outdated mode of care.
Dan L. Fortenbacher, O.D., FCOVD